ASTDD: Members’ Breakfast

Summary of State/Territorial Activity

April 30, 2006

Estimating Frequency of Dental Visits, Children < 3 years, Alabama 2006

Purpose – Treated and untreated caries, among children < 3 years in dental office. $1.5 million expended by AL Medicaid for dental care of 1-3 year olds. “If you’ve waited to age 3, you’ve waited too late”. “No one ever told me how to take care of my 2-year olds’ teeth.”

Method – Questionnaire developed, to be piloted and sent to 72 pediatric and xx Medicaid child providers. Staff complete form Monday and Tuesday for 6 weeks for every child < 3 examined. Instructions given to complete questionnaire; FAX back each form end of selected days.

Outcomes – demographic characteristics, +/- institutional vs homebound child, principal caregiver. As percent of all < 3 year old examined:

– caries experience, and – no decay/ some decay/severe decay. (terms defined)

Collaboration with dental school (student research project), AL-AAPD, Medicaid Agency

Limitation – some estimate (underestimate) of children having received dental care at this age, though excludes children with/without caries who have not seen a dentist.

Dissemination of results in ALDA/Medicaid newsletter/other publication

Project to start summer or fall, 2006

ALASKA:Adult Dental Medicaid Enhancement

Purpose: Expand coverage to include preventive and restorative dental services for adults enrolled in Medicaid up to a $1,150 annual cap

Target Population: Adults enrolled in Medicaid (including pregnant women)

Partnerships: Alaska Mental Health Trust Authority – new Alaskans for Dental Access Coalition (ADAC)

Cap: $1,150 level would cover an upper/lower denture over 2 years Key Feature: Assists financing of tribal programs, financial support to new

CHC dental programs and access for adults with disabilities (Trust Beneficiaries)

Key Feature of Efforts: New partnerships and resources Outcome: Legislative Results - update Next Steps/Future Direction: If the bills pass it would be implemented 4th

quarter FY2007 – if not, ADAC will develop strategies for next session.

New Hampshire – NH StatewideSealant Project (NHSSP)

Purpose: Create a sustainable statewide school sealant project and compare school-based with school-linked and Ohio models

Target Population: 2nd and 3rd graders

Key Features: – Dr. Margherita Fontana presented sealant science in NH– NHDS recruited 83 volunteer dentists for school exams– 349 2nd & 3rd grade students in 170 schools received sealants; 69

were referred for urgent care

Accomplishments:– Engaged communities & dental professionals to support evidence-

based dental sealant application Next Steps: Complete Years 2 & 3, Evaluate, Sustain sealant

initiative in 4 pilot communities.

Arizona – Transmission Campaignhttp://azdhs.gov/cfhs/ooh/itd_index.htm

Arkansas – Fluoride: The Natural State of Water

Create awareness of fluoridation as an adjunct to the natural occurrence of fluoride

Target Population – Runners, Walkers, Readers, dogs?– Stop the Pop => F:TNSoW– “Oral Health: Something to Smile About “– Medical Mile Mural Wall

State of California Community Water Fluoridation Program

Increase the number of Californians drinking fluoridated water from 30% to 65%

All Californian’s, especially high risk, low income children Passage of AB 733 and SB 96 California’s Fluoridation Laws Development of Partnerships Securing the necessary private/public funds. Anti-law suits, CA courts uphold AB 733 By early 2007, 65% of Californians should have access to fluoridated

water Continued guidance to communities in the process of fluoridating Securing federal, state, local and private funds Maintaining fluoridation oral health partnerships and coalitions Developing additional state laws mandating oral health prevention.

Colorado: Mercury-Free ColoradoOral Health Program Role

Integrate “dental” into Mercury Environmental Problem Solving Team

Target Population: Colorado Dentists 1. Liaison between CDA and Health Dept. 2. Presentations at component meetings regarding

voluntary use of amalgam separators 3. Development of Hg Manual for Dental Offices Accomplishment: Support of the CO Dental

Assoc/Integration between “health and environment” Next Steps: Oral Health Director as “point person”

CONNECTICUTBasic Screening Survey

Purpose:– To Gather Baseline Oral Health Data on Preschool and Elementary School

Children in CT Target:

– Head Start, Kindergarten and Third Graders Features:

– Statewide and Regional Representation– Decay, Location of Decay, Rampant Decay, Sealants

Accomplishments:– Broad-Based Support– Advisory Committee Established and Convened

Next Steps:– Sample Selection

District of Columbia – Dental Professionals’ Role in Bioterrorism & Other Catastrophic Events

Purpose – To determine the role that dental professionals can play in response to bioterrorism and other catastrophic events

Target Population – District of Columbia residents & Metropolitan area Key Feature of Efforts – Collaboration with DC DOH’s Emergency Health & Medical Services

Administration Accomplishments:

– Participated in emergency response team at 55th Inauguration of the President of the United States on January 20, 2005

– Provided dental treatment to Hurricane Katrina evacuees– Key note speaker at DC DOH’s 2nd Oral Health Summit was Dr. Michael Colvard (Director,

Disaster Emergency Medicine Readiness Center &Assistant Professor , College of Dentistry, University of Illinois)

Next Steps:– Collaborate with Howard University College of Dentistry to develop curriculum to prepare

dental professionals to respond to bioterrorism and other catastrophic events– Train dental professionals to effectively respond during times of crisis

Idaho – Head Start Oral Health Initiative

Purpose: To promote oral health and increase access to dental care for Idaho children

Target: Low-income children and families Kick-off: Nov ‘04 HS Oral Health Forum Oral Health Plan Follow-up: Mtgs, trainings, grants, screenings/fluoride varnish Collaborations: ASTDD, IHSA, IHSCP, HS Programs, Delta

Dental, IOHA, RBS Caring Foundation, State/District Hlth Depts. Outcome: Increased funding and priority for oral health, increased

knowledge about best practices, increased services PIR data Next Steps: 2006 Idaho Head Start Smile Survey – Oral Health &

Wellness Track at 2006 Idaho Health Care Conference – Continue Collaborations - Bright Futures Guides/Training – ECC Prevention & Fluoride Varnish Project – Perinatal Oral Health Project

Illinois: Collecting Workforce Data Through Licensure Renewal

Purpose– Respond to state oral health plan– Key concern for Communities, Deans, ISDS– Goal: FTE equivalency by county– Feed IOHSS

Target population – Clinically Active DDS/RDH Key Features - Collaboration Accomplishments – 62% RR DDS; 70% RDH Next Steps – SB 2395

– Department may require completion of a census by all licensed dentists in order to obtain relevant information regarding the availability of dental services within the State

SEAL INDIANA: Indiana University School of Dentistry’s

State-wide Mobile Dental Sealant ProgramIn Cooperation with

Indiana State Department of Health

DATA: March 2003 – March 2006

9,220 children examined to date 14,214 sealants placed 6,213 fluoride varnish Programs at 464 sites in Indiana

– Title I Schools, Community Health Centers, Head Start Programs, Seasonal Migrant Programs

52% 6-18 yrs have untreated decay– 35% 6-18 yrs have non-urgent decay– 17% 6-18 yrs have severe carious lesions

Payment– 54% Medicaid / Hoosier Healthwise– 25% sliding fee scale– 17% agency– 3% no charge

Iowa – 2005 Senior Smiles Project

Purpose: Train public health nurses in three Iowa counties to assess the oral health status of home bound senior citizens, provide basic home care instructions, and appropriate intervention

Target Population: 146 senior adults participating in the Medicaid Elderly Waiver Program age 65 and older

Key features of efforts:– Collaborative effort between IDPH, DEA, U of I Dental School– Adapted screening tools, Oral Health Assessment Tool (OHAT),

Oral Hygiene Care Plan (OHCP) for effectiveness evaluation Outcome: OHAT showed improvement in oral health status from the

first screening to the second, 83% of participants were referred to a dentist

Kansas

AEGD Program

Dr. Katherine Weno

KENTUCKY KIDS Smile Program

Purpose (Objective) - KIDS Smile Program Target Population – Children ages 0 thru 5 yrs Key Feature of Efforts – Non dental providers Key Feature of Efforts – State-wide Key Feature of Efforts – Tobacco Settlement Accomplishment/Outcome – 57K visits, 1250

nurses, physicians, others trained Next Steps/Future Direction – add other non

dental providers, clinical & admin eval

MAINE – State Oral Health Plan

Purpose: Develop a collaborative statewide oral health improvement plan that engages all partners

Target Population: Policy-makers and stakeholders Key Feature: Collaborative process; broad base of

diverse stakeholders; some new players Accomplishment: To be incorporated by reference

in State Health Plan (first time) Next Steps: Plan is in final draft stages; once final,

will develop implementation plan; presentation planned at statewide conference in fall 2006

Commonwealth of Massachusetts“Early Oral Health Assessment Project”

Early dental assessment and education for families with children at high-risk for dental disease

Families and Children participating in Early Intervention and WIC

Non-Dental Professionals Periodic Oral Health Assessments Dental Tool Kit Consultation/Referral to “Oral Health Across the

Commonwealth Program”/Tufts Special Needs Dental Program

MichiganInfrastructure Development

Objective: To develop a sustainable infrastructure Accomplishments:

– Personnel growth– Coalition, State Oral Health Plan, Disease Burden

Document– “Count Your Smiles Survey”, Fluoride Varnish/WIC

Program– Budget redistribution to oral health

Next Steps: – Increase integration of oral health throughout MDCH

Minnesota – Oral Health Data Book Project

Goal – produce a MN Oral Health Data book in print and web formats

Used by communities for targeted oral health program planning Key Feature – MN specific Key Feature – availability via web Key Feature – aid in identifying dental program gaps Accomplishment – will be completed mid-summer Future direction – develop oral health programs based

on identified data needs Funded – HRSA through its Children’s Oral Healthcare

Access Program (Thank you HRSA!)

Mississippi – Public Water Fluoridation Program

Increase proportion of population on fluoridated water (Range = 0.7 – 1.3 PPM Fluoride)

PWS that serve 1000 residents or more Health foundation partnership to give funds to PWS (

http://www.bowerfoundation.org/) Risk reduction surveillance using WRFS Access for health providers to ‘My Water’s Fluoride’ 26 new programs = pop. increase from 42% to 50.5% The Mississippi Gulf Coast / Clean Water State

Revolving Loan Program (? legislation)

Nevada – Oral Health Coalitions

6 Regional Oral Health coalitions and a State Oral Health Advisory Committee

Develop and implement community-based strategies to improve oral health, reduce disparities

Shared website www.nvoralhealth.org Accomplishments/Outcomes – Smiles Across America

LV, 1DAY, Head Start resources, LTC/SNF-Assisted Living curriculum, CE for volunteering, data collection of special needs population

Next Steps/Future Direction – Coalition workshop, 2006 State Oral Health Summit

New Jersey: Dental Clinic Directory 2006

Purpose: To provide a central source of information on NJ public dental clinic services.

Target Population: Public, health and social service professionals

Available on NJDHSS website, hard copies

Living document

Future Direction: Annual updates

1 2 34 5 67 8 9

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New York State –Guidelines for Oral Health Care During Pregnancy and Early Childhood

Target Population – Prenatal oral health and child health professionals Purpose - To develop and recommend scientifically sound guidelines that are

practical and provide the greatest opportunities for improving the oral health of pregnant women and children.

NYS DOH convened an expert panel of health care professionals who are involved in promoting the health of pregnant women and children.

The panel reviewed literature, identified existing intervention practices and guidelines, assessed issues of concern and developed recommendations.

Group relied on expert consensus when controlled studies were not available to address specific issues and concerns.

Accomplishment/Outcome – Separate recommendations for prenatal, oral health and child health professionals were developed by the panel.

Next Steps/Future Direction – Guidelines have been submitted for publication approval.

Presentation: Pregnancy and Oral Health: Evidence and Opportunity, Wednesday, May 3, 2006; 2:15-3:15 pm.

North Carolina: Reinstitute Fluoride Mouthrinse Program

Purpose (Objective): Reduce inequities between high and low risk children

Target Population: 78,000 children in elementary schools at or above 40% free/reduced lunch

Key Feature of Efforts: Focus on high risk children Key Feature of Efforts: Decrease school

requirements Accomplishment/Outcome: Request for funds is

being reviewed for the Governor’s expansion budget

Next Steps/Future Direction: Obtain funding

North DakotaBasic Screening Survey Results

Purpose: Surveillance 53 schools included in a probability sample 3rd graders; 50 schools; 1,015 children; 73% participation rate 2010 Sealant Objective: Met (53%), for American Indians (AI)

sealant rate much lower (43%) Caries experience 54%, AI caries experience 82% Drank soda or other sugared beverages 79%, AI 88% ND has drafted a burden document, scheduled for release in the

fall. Build case for American Indian sealant pilot project. ND Oral Health Coalition, drafting legislation to allow non-dental

providers to apply fluoride varnish.

Oregon- A Targeted Approach to Sealant Promotion

Purpose: Promote school based local sealant projects Population: 2nd and 3rd graders in schools with 50%

FRL program Key Features: Sealant Strategic Plan, Targeted

Counties, County Synopsis, Promotion Materials (fact sheet, cost savings analysis, cover letter, dental sealant manual upon request)

Outcomes: All sites have responded with interest Next Steps: 1) Technical assistance to sites, 2)

Seeking ongoing State GF for Sealant Program

PENNSYLVANIA: Expanded Function Dental Assistants (EFDAs)

1. Increase access to oral health care2. Underserved Populations or Low-income, uninsured, CHIP and MA recipients3. Partnered with Harcum College and Luzerne County Community College (Urban vs. Rural) 4. Trained 86 EFDAs5. Educated 250 dentists and dental students on the advantages of using EFDAs6. Pennsylvania EFDA Association established7. The effectiveness and success of the EFDA Training Program

Rhode Island – State Oral Health Summit, March 2006

Objective: Convene broad group of stakeholders to develop a new 5-year OH plan for RI

Target Population: All Rhode Islanders

Key Features:– Acknowledge accomplishments of 2001 Senate OH

Commission; consider current OH issues in RI– Solicit stakeholder feedback - Draft OH Plan

[101 partners representing 53 organizations]

Next Steps: Final 2006 RI Oral Health Plan Other: Anti-fluoridation legislation, 2006;

CSHCN OH Forum [Fall 2006]; BSS 3rd grade [Spring 2007]

South Carolina – More Smiling Faces RWJF Funded Pilot Project

Goal: Increase access to oral health care Population: Children < 6 and CSHCNS <20 Strategies:

– Created integrated network in 6 rural counties – Provided Pediatric OH Training for medical/dental providers– Linked child from medical home to dental home with a patient

navigator– Provided community education and outreach

Measurable Goal: Increased Medicaid utilization for both target populations significantly

Future:Integration into MCH Integrated Systems, Medical schools, dental residency program, Head Start, etc.

South Dakota –Partners for Prevention

HRSA Healthy Tomorrow’s Partnership grant Train Primary Healthcare Providers Physicians, PAs, Nurse Practitioners, CHNs Pediatric dentists provided initial training Referral system? Discuss Medicaid reimbursement with DSS? Question – partner with? Donated Dental

Services, DH school, FQHC, Care Mobile

Tennessee – Cavity Free in Tennessee

Purpose- To train public health nurses to perform a dental screening and apply fluoride varnish to at-risk children in health department medical clinics

Target Population- Children 0-5 yrs of age seen in health dept medical clinics

Statewide training of nurses by dental staff July 04 - June 05: 8,747 children had a dental

screening and fluoride varnish application by public health nurses

Texas – Texas Health Steps Dental Program/ Update of Medicaid Dental Policies

Objective: Align Medicaid dental policies with current dental practices

Target Population– Approximately 2,600 enrolled dental providers– 2.7 million Texas children enrolled in Texas Health Steps

Proactive review of Medicaid dental policies Medicaid dental provider stakeholders’ involvement

– Identification of issues/concerns and solutions Updated diagnostic, preventive, therapeutic, and

Doctor of Dentistry policies; orthodontic in process Continue quarterly stakeholder meetings and ad hoc

workgroups

Utah - “Mind Your Mouth” media campaign (2nd Year) First dental visit by one year of age

Purpose: Educate public and dentists of the importance of first dental visit by age one

Target Population: Parents/caregivers, dentists Key Feature of Efforts: TV and radio spots Key Feature of Efforts: Urban and rural areas Key Feature of Efforts: Spanish translation Accomplishment/Outcome: To be determined Next Steps/Future Direction

– 3rd year: Continuation of first dental visit by age one

Vermont – Community Water Fluoridation

Burlington and Montpelier, VT

Board of Health and City Council votes

Petition by Fluoride Action Network and Safe Water Advocates of Burlington

Collaboration - VDH, VSDS, VMS, VDHA

Landslide victory for fluoridation…. 71%-29%

Consideration for statewide mandatory fluoridation effort

Washington State – Oral Health Burden Document

Purpose: To provide data, guidance and education for decision makers

Target: dental professionals, legislators, communities, local health departments

Key Feature of Efforts: internal DOH data, data from partners, final input from partners

Accomplishments: more visibility to OH issues, new partners, more credibility to OH Program, better coordination of efforts, system view

Next Steps: basis for State OH Plan (through local and state coalitions)

Wyoming Early Childhood Caries Prevention

Purpose: Reduce early childhood caries incidence Target Population: Pre-school children Key feature of efforts: Screening, education, referral

and follow-up Key Feature of effort: Public Health Hygienists in eight

counties Outcomes: Demonstrated reduction in number of

cases requiring hospital care Next Steps/Future Direction: Extend program to include

all Wyoming counties in two years